I am often asked about the number one mistake when people are confronted with the possibility of ADD/ADHD. If you have been reading this blog for any length of time you would probably know what my answer will be: Misdiagnosis. By this I mean that many parents simply accept the suggestion that their child might have ADD/ADHD at face value without seriously investigating whether this is indeed the case. Given the implications of such a diagnosis within the context of the medical establishment (e.g. the prescription of strong medication targeted at changes in brain function is almost certain to follow) this omission is quite startling. I suppose it can be explained by the fact that most of us have an almost blind faith in the pronouncements of the ‘experts’. This can be a dangerous position: Especially when it comes to something like ADD/ADHD where hidden agendas and the possibility of fortunes (for drug companies) comes into play.
This is why it has become something of a habit of mine to say: ‘Wait a minute are you absolutely sure!?’ whenever an ADD/ADHD diagnosis is mentioned. There are simply too many other possible explanations around for anyone to simply accept the first suggestion that the condition might be present. This is why I have been working on something that I call the ‘Misdiagnosis Files’; listing and discussing possible alternative causes that should be researched before a definitive diagnosis can be reached.
This week I would like to shine the spotlight on a major cause of ADD/ADHD misdiagnosis: Vision problems. Simply put, many children are diagnosed with ADD/ADHD while the real problem is that they simply can’t see well enough to function within the classroom context!
It is easy to see how misdiagnosis can happen in this case. About 20% of school aged kids are prone to problems with eye teaming (meaning that their eyes don’t work together as well as they should) or focusing. This means that they struggle to focus on tasks requiring good vision (in other words most of the things that they are required to do at school!) for long periods and are therefore easily distractible. It can also lead to what might be perceived as careless errors and the failure to complete tasks on time. Does this sound familiar? Yet, in their case the problem is not down to ADD/ADHD but to the discomfort arising from attempting to focus and control their vision.
I am, in light of the above, absolutely convinced that no child should be formally diagnosed with ADD/ADHD until vision problems have been ruled out. You can do this in the following ways:
1) Start with simple observation: If you think that your child may have vision problems the first basic thing to do is to observe him or her going about simple tasks. Do you notice a lot of squinting? Do they bring printed materials very close to their eyes (or attempt to hold it as far away as possible)? Do you often hear complaints about headaches?
2) Get a thorough eye test done: The obvious second step if you identified any of the factors listed above is to get your child’s eyes checked out professionally. My suggestion would be that you try to find someone who specializes in pediatric eye testing as he/she will have more experience in identifying some of the vision related links between eyesight and poor attention.
3) Keep monitoring the situation: If a vision problem is indeed present you will obviously be presented with suggestions for possible corrective measures. This will in many cases include spectacles or some other form of vision correction. It will be your job to ensure that these measures are effectively applied. Yes, it can sometimes be difficult for a child to consistently wear glasses but you will have to constantly point out that the benefits will far outweigh any perceived negatives. If the child is older and spectacles are regarded as totally ‘uncool’ it might be worth your while to investigate the possibility of using contact lenses instead. Your vision professional will be able to advise you in this regard. Your job of monitoring will also have to include an evaluation of whether the problem is indeed being solved by the prescribed corrective measures. If not, you will have to keep plugging away at it until a solution is found.
4) Help your child to ‘catch up’: If your child is new to vision correction it is quite likely that he/she might have fallen behind at school during the period before the problem was identified. It is therefore highly recommended that you identify the knowledge/skills gaps that arose from this period and that you do your best to address it. Your child’s teacher can be an invaluable source of information and help in this regard.
Allow me to end with a simple plea: Make sure that you have exhausted all alternative explanations before accepting an ADD/ADHD diagnosis and make sure that possible vision problems are an important line of inquiry in this regard.
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